Rural Medicine Archives - The Best Mouse Tap

Modest Expectations – All States of Being Are Without a Self

“Less than 10 percent of the 280,000 species of flowering plants produce blue flowers”

I love blue flowers. I remember there were masses of hydrangeas growing in Victorian Gardens. They were blue, pink, white and variegated. First cultivated in Japan, they are found worldwide in the wild, without there being a single source from which they first grew. There are even Australian hydrangeas with small cream flowers vaguely resembling jasmine and found along streams in NSW and Queensland.

They are a garden flower; brought indoors they are somewhat “crowded house”. They need a big canvas upon which to show off. Living in a maisonette, small rooms just tended not to be the best place to display these flowers. I was told that if you put copper filings in the soil, there would be hydrangeas blue; and if an iron nail is put in the soil, hydrangeas pink.

This formula was not true, truly mythical. In acidic soil with aluminium sulphate as the key component, in a temperate climate, then the blue hydrangea blooms. Quite the opposite of the litmus test, which always records acidic soil as pink.

The scientist’s quote above says it all. Flowers are uncomfortable with blue pigments. Yes, the Japanese have created a blue chrysanthemum by genetic manipulation. Of the few true-blue flowers, if you discard the intrusion of the various shades of red and indigo, all are a delight – well at least for me. If you treasure these flowers then one of the times to be in England is in early spring when bluebells come out in a riot of colour for a few weeks and then retreat, leaving the lush greenery of a well-watered landscape bereft.

Cornflowers are the spiky kid on the block. They have their day at the Spring Racing Carnival in Melbourne when they are the flower of Derby Day. With their small confident upright stance, they make an excellent lapel adornment.

A symbol of hope, the cornflower is the national flower of Germany – and the basis for Prussian blue. Its name was derived because it grew in the wheat, barley and rye fields. There is an Australian native cornflower, but the flower is different in configuration, but given the cornflower has the feel of the Australian everlasting, our version is found in arid regions.

But my favourite is the delphinium, with its tower of blooms. There are various shades of blue but given there are apparently 300 different species and apparently they can be either merged with larkspurs or they remain close relatives, this flower from the high mountains of Africa and Europe is my favourite blue, because there is more than one shade of blue.

They tend to have a brief expression of glory. As one writer put it: Sadly, the flowers were short-lived. And being tall with a heavy abundance at the top of each stalk, all it took was one heavy rain to knock it over and send the flowers sprawling all over the grass. I enjoyed it while I could, and after my first summer, I sunk a tall rose climber into the ground to support the top-heavy stalks and protect them from heavy rain.

When I see the delphinium begin to drop its flowers, it should be realised that they are toxic. In fact, all parts of the plant are toxic – the active ingredient being the neurotoxic effects in the flower’s diterpenoid alkaloids.

So be wary if your herbalist friend offers you delphinium tea.

In explanation of my blue reverie, I’m very visual – how could I ignore the blue hydrangea!

The War of Jenkin’s Ear

Well, we know what happened to Robert Jenkin’s ear. It was sliced off in a confrontation between Jenkins, who was the captain of the British brig Rebecca, and the Spanish coastguards who boarded his ship off Cuba in 1731. Eight years later it was the casus belli for the British Government to declare war on the Spanish. Jenkins had appeared before a Parliamentary Committee to tell his story and allegedly show the Committee his severed ear. Shock, Horror – and the British declared war on Spain in 1739.

It was a desultory affair confined to the Caribbean, except in British eyes the capture of the Portobelo fortress by Admiral Edward Vernon (the man incidentally who gave us the word “grog”). Portobelo was a Spanish possession on the Caribbean coast of what is now Panama. It led to much rejoicing and inspired the writing of “Rule Britannia” and the name has been immortalised in the name “Portobello Road” in both London and Edinburgh. This war ended up merging into the European dust-up, the War of Austrian Succession. In fact, the name was coined in 1858 by the historian Thomas Carlyle; but the name has persisted.

Now the dilemma of Trump’s Ear. The world has moved on. Trump has had a pillow completely obscuring his right ear at the Republican convention. Now Trump said he was shot. The media have taken that as gospel; and even the sceptics say the bullet grazed his ear. The gunman had a high-powered rifle sufficient to kill one of the spectators and injure two others. The gun was not a pop gun.

I have looked at the right ear in the multiple photos available. He has a bloodied right upper helix of the ear and what appears to be clotted blood in the triangular fossa. A medical opinion later said it was a two cm cut.

What surprised me was there seemed to be no indication of the aural cartilage having been damaged, but then maybe the angle was distorted. However as one who has seen and sewn up a cut ear, it is not a trivial exercise. There just did not seem to be any damage in Trump’s ear. A bullet striking the ear, however you measure “grazing”, would have left its mark on the ear cartilage.

Turning to the Trump face just after he emerged from beneath the lectern, there was a smudge over his right mandible, but what intrigued me were the two thin lines of blood which seem to arise without relation to the bloody ear. They are thin straight lines which converge on his lips. The lower line seems to defy gravity by starting at the base of his mandible with no discernible source and moving upwards. Somebody might explain it, but then it was all too trivial. Trump said he was shot and that man with his history of fable telling must be believed.

And hallelujah, if you removed the ear dressing, the ear would appear normal – just a God given miracle.

Later, his controversial doctor, Ronny Jackson, stated that Trump sustained a two cm wide wound from the track of a bullet “that extended down the cartilaginous surface of the ear.” No sutures were required for Trump’s wound, Jackson said, but “there is still intermittent bleeding requiring a dressing to be in place”.

What an amazing bullet! It initiated a two cm cut without damaging the cartilage? I liked the last bit about the intermittent bleeding. Is Trump on anticoagulants?

We await the water stroll, or before that intercession by His Buddy, will Trump’s failed assassination just merge into the War of the Trump Succession?

Paper, Paper Everywhere and not a Thing to Show for It

We’ve been clearing out boxes and boxes of papers – a concentrated episode of nostalgia. Some files are just thrown out, because the link with that subject matter was tenuous and I wonder why I kept them. Yet there are the others, which attract both my amateur archivist interest and nostalgia at the same time. They are files which showed something in which I was involved.

Nevertheless, more than a passing comment, those committees or matters on which you have the minimal involvement of the passing observer are far too common. It is one of the pitfalls of trying to involve every person or organisation that those in authority think are relevant or politically important. Then they either do not turn up with or without an apology or the representative attends, contributes nothing, is basically unprepared and then at the next meeting a different representative attends without any real interest, and at what cost. So much “shuffling the sand” and getting nowhere.

I was asked to undertake a Rural Stocktake to ascertain what should be done to encourage doctors to go to the country. The then Minister of Health, Michael Wooldridge, had as one of his priorities, improvement of rural health. One of the tangible expressions of this was the improvement in the rural medical workforce, which in turn would flow onto improvement in the health professional workforce, including the Aboriginal health workers. Whether this could be construed as a “trickle-down” phenomenon, or a coincidence, was a question which I believe after all these years relies on a successful multi-professional approach. This is difficult to achieve because each profession, because of regulation and tradition, will be ever-present, especially where conflict between the various entities is provoked.

The original terms were that it be a three-month consultancy, that there would be a committee to help me and I would have the Department providing me with administrative assistance and at times one of the bureaucrats travelling with me. I was given an Optus phone, which in those days did not have enough rural coverage to be of any use. The Department would write the Report.

What happened? The consultancy was extended for six months; the committee might have met once at the very start. The makeup conformed to what I have said about Committees. After I had completed the Australia-wide consultations which absorbed the whole six months, I wrote the Report, which took three months for which I did not get paid. But it didn’t stop the politicians questioning the amount of money my company was paid. Some of them were taken aback when I called them directly and asked the basis for their concern. Not much came of that except mumbled responses.

The problem was that at that time, I was close to the Minister, which attracted the normal set of “maggots” who seem to think everything is rotten in such a relationship, only to find out that there was nothing there. Our affinity rested on the desire to get things done.

In addition, the Secretary of the Department, Andrew Podger, whom I did not know previously, was extremely progressive and fitted into the Wooldridge agenda. When Wooldridge retired prematurely, my view was that it was bad for his unfinished agenda and not particularly good for himself personally. But that is life.

The Stocktake involved me travelling around Australia, but I had the advantage of already having been involved in rural health issues really since the first week after medical registration, even before I started my first year internship. Then with my then wife, who had also just graduated, we undertook a locum in Birregurra in Western Victoria. That was January 1964.

These days doing such a locum just after graduation is debarred. For God’s sake, one has gone through five or six years of a medical degree, and the graduate doctor cannot practise unencumbered. It is one of those expensive unproven exercises that are imposed by authoritarian administrators without any real evidence. However, there is a more insidious reason and that is in the pursuit of private practice, teaching recent graduates is relegated down the list of priorities. Has anybody calculated the cost of this? No, because it is easy to bluff politicians with words like “safety” and “malpractice”, although the doctors do not retain the omniscience they once had.

Wooldridge agreed with the major recommendation of the Stocktake to establish a series of rural clinical schools linked to universities which already had a medical school. I reported in March 2000. Twelve months later, in anticipation of the 2001 Federal Budget, Wooldridge announced in Bairnsdale the creation of rural clinical schools, the Bairnsdale site being part of the Monash rural clinical school. Funding was provided for another seven sites. It was an extremely quick adoption of the Stocktake recommendation.

At the time the Universities with medical schools were enthusiastic. With most of them I had extensive consultations, which were also facilitated through other links. Wooldridge was able to fund the rural clinical schools directly through his Health budget rather than through Education where the central administration of most Universities generally skimmed off a percentage of this funding for “God-knows-what”.

The aim was to train a cohort of medical students in their clinical years in a rural setting. For instance, the University of NSW Rural Clinical School would have nodes at Albury, Wagga Wagga and Griffith. One of the ways the Stocktake was crafted was get the country areas and the universities positive. As those who are familiar with rural Australia know, there are intense rivalries (e.g. Albury vs Wagga Wagga). It is one of the problems of rural living and, as a rule of thumb, the closer the townships often the fiercer the rivalry, which makes collaboration a tricky business.

Then within each of the townships, there is conflict between professions, and this needs some degree of massaging. Nevertheless, there was a need to involve general practices as teaching sites. There was already a registrar training program where the Government funded the Royal Australian College of General Practitioners (RACGP). The problem was while there were good teaching practices, many used their registrars as “mules” just doing unsupervised consultation on government funds – in effect “double-dipping”. The entry of the Australian College of Rural and Remote Medicine (ACRRM) with their initiative of the “rural medical generalist” coincided with the approval of the medical School at James Cook University in Townsville, with subsidiary campuses at Cairns and MacKay. Ian Wronski, who was a leading academic with long experience working in Northern Australia, particularly the Kimberley, was the driving force behind the initiative; I prepared the submission and Wooldridge approved it. The process was open, the arguments persuasive.

Townsville, home of the medical school in the tropics

Wronski, in pursuing this agenda, not only created a rural medical school in the tropics but also saved the University which had built up a reputation in marine biology but very little else. Wronski then developed schools of dentistry, allied health professionals, including nursing and veterinary science.

The other part of this approach to rural health had been the creation of University Departments of Rural Health (UDRH). The first two sites – Broken Hill and Mount Isa – were chosen because of remoteness, because the aim was to have a multicultural training centre in population health. The concept was new, but I was able to obtain locally-based allies in both cities.

The UDRH program has been successful in the number which have been created (12) but they have strayed from the original intention of the program to integrate population health into clinical practice. However, the progression of the program has been hampered by the failure of the Rural Health Commissioners to progress the agenda and so the program still has limitations in its ability to satisfy its original aim.

The Hanging Participle

John Funder AC is a sage and probably would be happy to hear himself described as a polymath. He is the father of the best-selling author, Anna Funder.

Jesuit-schooled, Funder is one of the few who took the traditional Classics whilst at school, Latin and Ancient Greek. An excellent orator, Funder usually was able to navigate the shoals of academic research and university politics with ease. We knew one another from shared university and post-university experience, never close but generally experiencing entertaining interactions when we did.

But I was surprised one day to receive a note, commencing as always charmingly:

Dear Beastie,

You’ve done it again. Not only is “The Best of Best” terrific as it routinely is, but the underlined sentence is now the benchmark for the floating (a.k.a. hanging) participle.

The underlined sentence occurred in an article where I was mentioning being at a retrospective at the Museum of Modern Art honouring the Finnish architect, Alvar Aalto. The year was 1998, the centenary of Aalto’s birth, and for those unfamiliar, he was inter alia the original architect for the modern hospital, producing those characteristic airy flowing designs, so different from the forbidding Victorian hospital design,

And the sentence over which Funder waxed lyrical: Wandering around the pictorial display of Aalto’s genius, interspersed with scale models of his various buildings, there is certain familiarity.

Well, at least I could sit down on my benchmark to recover from such a gust of praise.

Mouse Whisper

This would appear somewhat relevant to what is going on with the current Construction, Forestry, Maritime, and Energy Union (CFMEU) conflict with all the associated heavy-handedness.

This observation appeared in the Column 8 of the SMH some years ago. A reader wrote that he had seen a truck with what the writer described as a flamboyant sign: Rough as Guts Constructions. The number plate on the truck, YAH-HOO.

Modest Expectation 271 – Two French Horns Join In

When the Defence Department advertise for recruits their first message is not that you are liable to be killed. However, when the rural medical profession wants to send a message, it uses the equivalent negative message as though rural medical practice is so hard that inevitably you will burn out under the weight of patients – an isolated martyr on the cross of medicine in the vastness of this Land.

I firmly hold the opinion that all medical graduates should be fully licensed to practice on graduation. After all, what is the long undergraduate program there for, and the intern year should fully provide the opportunity to develop the skills necessary to not only deal with emergencies but also to recognise emergencies. The importance of collegiality is to recognise when you are out of your depth in dealing with an emergency and to not fear calling for support as if making a mistake is a felony, because we all do make errors. The earlier that recognition, the better for you, and moreover more importantly for your patient.

I graduated long ago when the profession was predominantly male, but my first wife was in the same year and I viewed the misogynistic remarks, the discrimination, and in one case undue professorial interest towards her, which would be completely unacceptable today. She was diminutive and beautiful, but when one drunken medical student tried to molest her, she flattened him with a punch which would have done justice to any featherweight champion.

It was a more uncomplicated time for men, but not so for women. Medicine had not differentiated, and there was a defined route to general practice. In first year residency now renamed “intern”, it was when, in my outer urban hospital, there were medical, surgical, and in the emergency department, three month rotations. The other rotation was ENT, at a time when if you survived childhood with your tonsils intact, you were lucky. I and my companion resident medical officers were presumed to be destined for general practice.

Tonsillectomy was then common, and it was one technique that the general practitioner, who wanted to be competent as a surgeon, needed to master. Even in the teaching hospital, the intern developed skills, saw more patients then, so that by the end of first year, one accepted that life as a doctor was not part-time and “quality of life” was a secondary consideration. Moreover, as a young graduate one got used to the night call; it was part of the implicit social contract with the community.

Thus, the hospital residency was concerned with acquiring skills but also reconciled to responsibility being a doctor entailed. One had to do a year at the Women’s Hospital and a year at the Children’s Hospital as part of general practitioner training. There was an optional year in the general hospital where anaesthetic skills were consolidated and there was a further opportunity to improve procedural skills. There was no examination if you wanted to be a general practitioner. Your credentials were your references gained from what you had done in your three or four first post-graduate years.

Since those times, an accepted course unencumbered by bureaucratic regulation, which provided a recipe for procedural general practice, has all but disappeared. It should be emphasised that the medical staff within the hospital, either salaried or “honorary” had a strong commitment to teaching, not going missing and “skiving” off into private practice or the research laboratory.

The immediate response to this is that it’s an exercise in nostalgia for a long past professional development, unencumbered by the strangulation of bureaucracy enacted by governments with no knowledge of medicine. The profession bears the blame to some extent, relying on the mysteries of medical care leading to a gross asymmetry in the amount of information available to the community in an understandable form.

When I graduated, the profession was basking in the glow of the discovery of antibiotics and the Sabin oral polio vaccine. Investment in medical research followed. I spent five years in the Monash Department of Medicine undertaking both a Doctor of Medicine and Doctor of Philosophy, a case of excessive “diplomatosis” in modern terms. My research scholarship paid a pittance which meant I had to do a variety of professional jobs including general practice, working for the Army (it being the time of the Vietnam War), examining conscripts for fitness to serve, and tutoring medical students and junior medical staff.

Medical research to me was inspirational, but then I was working with some great scientific minds, far better than myself. Because of this environment, I was fortunate and my research, although mediocre, helped to elucidate the role of angiotensin in causing hypertension. One of the results of all research worldwide in this area were more effective drugs, among the most important discoveries of the twentieth century. The growth of the pharmaceutical companies with the need to discover drugs to maintain their viability resulted in the rise in the cost of medicines. Similarly, the improvement in the tools created a tribal approach as distinct subspecialties grew around each of these totems. For general practice surgeons, the rise of laparoscopic surgery was just one reason for the demise of the general practitioner surgeon, whose techniques became more and more obsolete when distanced from new lesser invasive techniques. Post-procedural morbidity in turn diminished.

The other factor was the growth of the emergency medicine specialty. I am not the only one to believe this was one of the detriments to medical practice. They are essentially able to resuscitate patients, which was once the domain of the general practitioner. But they have no collegiality, they are essentially medical gypsies, working set hours and providing an easy but expensive substitute in regional and rural Australia, working hospitals divorced from the community. They have no community identity and are only a locus along the ongoing care. Unlike the general practitioner, they deal with “objects” for treatment and some are undoubtedly very good, but in the end they never have long term patient relationships. Personally, I think the whole emergency doctor profession needs a detailed review, but unfortunately that will never happen. They are too entrenched, and unless there is some modification in attitudes, rural general practice will continue to suffer.

If one ignores these elements in bold below, then rural general practice will always languish. The concept of one doctor being able to be on call 24/7 is a prescription for burn out. Any medical practice in any township should not be less than three doctors; and four would be preferred. The problem of what I would classify combatting the element of isolation is often the enmity between neighbouring towns, the closer they are geographically it increases. Thus, constructing a setting where four doctors serve multiple townships is harder than it seems.

Another factor I have observed and about which I have never varied my opinion the more I was exposed to rural practice is social dislocation by which I mean where your spouse does not want to come or where you need to send the children away to school.

Then there was the question of being able to be accepted by the community in which one practises. There are many flash points which challenge the third element, community tolerance, by which as I have explained in the past is the ability to get on with the community you serve. Conflict between health professionals and then within the community must be resolved and not turned into a chronic festering situation. I’ve observed that, and it greatly hinders recruitment.

The fourth element is succession planning which is poorly done, but it is so important that it deserves a cohort of skilled people who can help the doctors to recognise their professional mortality but also that the length of service in a practice should be considered in five-year aliquots.

Money by itself is not an incentive; and importing doctors without sensitive planning can be disastrous. In the next part, I’ll discuss what works and how neglect, dissonance and dysfunction have crept into the system.

At the head of this piece is a photograph of a place where I have been several times. On the coast in the Far East, the border separates two large urban areas, Coolangatta (Queensland) from Tweed Heads (NSW). Pictured is the Warri Gate, on the Far West border – a gap in the dog fence that separates from Queensland from NSW, where there is no settlement, only a gibber plain that stretches northwards. The nearest settlement is the NSW speck, Tibooburra where the Silver City Highway ends. That is Outback Australia – silent ground covered with Sturt desert varnish. The only companion, a kangaroo watching us intently.

“Delay, Deny, Die” – The Diggers’ Cry

When I had only just turned fourteen at the end of 1953, I got my first job assembling medical files of returned servicemen (service women were rare) in the then Repatriation Department. My boss, I remember, was a very nice guy called Paddy Saxon. He, like most public servants, was a returned serviceman. He had served in WWI, was nearing retirement and had already signed off. The unassembled medical files had built up despite there being allocated overtime to deal with them. The chap whose responsibility it was for the files spent most of the day staring out the window and assembling files very slowly and in silence. He too had been an ex-WWI “digger” and it was a time when cognitive loss was just “old age”.

Reading the huge delays and the time needed to train persons in the current Veterans’ Department in assessing claims reminded me of my holiday job within the Department divided by those who took a positive view towards the returned servicemen’s claims and those who were inherently suspicious of any claims.

The reason that I knew about this difference in approach was by listening to my father, who was a doctor within the Department. He worked on the basis that those who had fought for Australia deserved compensation, unless otherwise indicated. He had served in the Navy during WWII, which interrupted his graduation as a doctor. This occurred in 1946 after which he undertook his first-year residency working at the Caulfield Repatriation Hospital from which he moved to becoming a salaried medical officer within the Department.

Before the War, he had graduated in both commerce and law, and like many such graduates, the Great Depression truncated his career prospects, and at my mother’s urging he started a medical course in 1935-6. Information about this progress is somewhat murky, but he rubbed the Professor of Obstetrics up the wrong way to such an extent that he was consistently failed, a situation which would be impossible these days – but that is another story.

Nevertheless, the legacy he left with me was a sense of confronting injustice, and with his armament of experience, he was a formidable champion of the diggers.

It is thus interesting to read about what now has been occurring in the Veterans’ Department, the successor to the Repatriation Department. There was a far greater load of claimants in his time, and he increased his irritant role in the Department by being the national Secretary of the Repatriation Medical Officer’s Association. He thus wielded substantial hidden influence.

I would suggest that if he had been in full flight these days he would have been very vocal over the behaviour of the previous Morrison Government in delaying the $6.5 billion being allocated, but then he had the returned servicemen backing him up. The Department found his forthright advocacy an irritant at the best of times, but he got things done.

As it was, as has been in reported some detail in the Melbourne Age,

In 2018, Scott Morrison said he understood “first-hand the battles so many veterans face when they leave the defence forces”, and argued that as a nation, more could always be done to recognise the men and women who had served in uniform. Unfortunately, that didn’t extend to processing veterans’ entitlement claims.

By April 2023, the average processing time for a veteran’s claim was 435 days, while 36,271 claims – almost half of those lodged – hadn’t even been looked at (known as “unallocated” cases).

This was a known and growing issue for the Coalition. In March 2022, then veterans’ affairs minister Andrew Gee threatened to resign unless extra money was put aside to clear the backlog, of 60,000 unallocated cases, veterans looking at their claim for financial support.

Morrison’s government employed outsiders through labour hire companies without any knowledge of what was required. Given the track record of government, somebody in the appointment chain may have received “a brown bag” with orders to obfuscate the claims process. Switching back to public service employees to undertake the work, by the Labor Government, the backlog of unallocated cases has reduced to just 2,569 and the processing waiting time, while still far too long, has dropped by 62 days. Staff has been increased.

In the Department of Veterans’ Affairs, it is said it takes up to six months to train the specialist staff responsible for overseeing claims. And so the previous government’s use of labour hire ended up being a disaster for the Department and veterans. Still, I find a six-month training program to be somewhat excessive.

The Age article goes on to praise Minister Keogh, Treasurer Chalmers, and Finance Minister Gallagher for clearing up this backlog “without fanfare”. In addition, they’ve made a conscious decision not to politicise a situation which was an absolute mess and ripe for point scoring and public criticism.

What is depressing is the lack of champions for the “diggers” within the Department, and the fact that the RSL has been strangely quiet, given there are 20,000 returned servicemen from Iraq and Afghanistan; and the Vietnam war veterans are now well and truly in the ranks of the elderly. However traditionally, this Department has not attracted the top grade bureaucrats, and moreover does not attract attention unless there is a Morrison – in other words “grandiose announcements and then stuff-up cloaked in religiosity”.

Also, when I was working for Repatriation Department, I assembled all the outstanding medical files, including the backlog, in less than a month. So much so that my supervisor told me to slow down. Instead, once I had no files to assemble in my in-tray, I went into the rooms where the medical files were kept, and with the enthusiasm of youth assembled the files of several high ranked officers not knowing if I was transgressing any regulation. In any event nobody stopped me. I was amused when I encountered what amounted to the brown hard back medical record. This was the venereal disease record, and there was no way this could be missed. It was an early introduction to my eventual medical career.

Not what it seems

The NSW Branch of the Australian Medical Association announced last Friday an exclusive offer of premium red wines discounted by up to 77 per cent, priced from $550 a bottle. Like all offers which seem to be too good to be true, I sought the reasons from a wine insider.

Yes, when I read the name of the wines out, they were individually fine wines. He further said that he tended not to accept the rating system, where 100 was perfection and hardly ever reached. He relied on his taste buds, the distillation of multiple cranial nerve connections with the mouth, including the complex innovation of the tongue. However, the ratings were there to reassure the potential purchaser.

The prices stated in the AMA advertisement were those projected for the overseas market. Unfortunately, when the tariffs were removed by the Chinese Government, the expected surge in the Chinese wine trade has not eventuated. The Chinese are not buying Australian wine; they have gone elsewhere during the time Australia was punished with high tariffs.

Added to that, wine consumption all over the World is falling, and this applies particularly to red wines – at a time when there is a glut of wines worldwide.

I note that ABC’s Landline ran a segment on the sale of Australian wines to India. The tone was optimistic, but I’m sceptical. Only a small percentage of Indians drink foreign wine behind a high tariff wall (150 per cent). Having ordered foreign wines and spirits in the various hotels in which I have stayed, you would think that Ned Kelly was an Indian, so great was the cost.

Alcohol cannot be advertised in India, which inhibits the adoption of wine, and even given the growing Indian middle class together with a growing number of Indians now living in Australia who retain family contacts on the subcontinent and can be used as a positive factor for an increase of wine’s popularity growth remains slow. One source warned nevertheless: “The majority of consumers are more focused on wine’s pricing and taste; since it is not an indigenous beverage, consumers often have only a basic understanding of the right etiquette to purchase, order, serve, or drink wine, nor do they know about wine regions and varieties in detail.”

Personally, I would never drink wine with a curry. Beer is the preferred drink if you need alcohol to wash down the vindaloo.

Completely Irrelevant as any Sporting record

One of the idiosyncrasies is how guys like Gideon Haigh and Bruce McAvaney have turned their encyclopaedic memory for sporting trivia into a career. Both have a dedicated following, as though retention of irrelevance confers some oracular status. For most of the community such modern Data Oracles are just dead boring, but then I would have found the Delphic Oracles not to my refined philistine attitudes – emoting rubbish to a rapt audience.

So, as with any good hypocrite, I have joined in to discuss the rise of a German football team, Bayer Leverkusen. The team was founded in 1904 by employees of the pharmaceutical company, Bayer. The company headquarters are in Leverkusen in North Rhine – Westphalia. Traditionally it has been an also-run team.

As The Boston Globe stated “Bayer Leverkusen are standing on the precipice of history” – whatever that means.

The narrative explained that this lowly German soccer team has just finished its Bundesliga season undefeated (51 wins), the first team to achieve the feat. Teams in other leagues may have gone undefeated, but none has ever done what Leverkusen had done in the Bundesliga. The ballon burst with the first of their final cup challenges. Leverkusen lost to Italian club Atalanta in the Europa League final 3-1. Leverkusen rehabilitated themselves by then winning DFB Pokal Final (German Cup) against the Rhineland-Palatinate club, FC Kaiserslautern 1-0 last Saturday.

Why the success? Hiring a smart guy with a chequebook.

Early last season, with the club in second-to-last place, they hired Xabi Alonso, a Spanish former midfielder with a very good coaching record. He made some shrewd signings, and voilà…

Leverkusen started well, salvaged six tied games and did not relinquish first place after the sixth week of the season. Must thank Gabe Edelman for this piece of priceless sporting trivia which obviously eluded my companion sporting bores. Who’s interested in German football in this Country when there are irresistible data about the number of runs made by JMux or the number of jockey premierships been won by David Wornout. Or did I get that wrong?

Mouse Whisper

One of the obscure topics the Boss was talking about was the Livery Companies of various trades set up in London from mediaeval England onwards when the trades began to band together as de facto Unions without the cloth cap association. The first were the mercers, from which the generic name of “Merchants” is derived. They were essentially traders in cloth, unsurprising given the importance of the wool trade to England at that time.

One matter which led to the phase of “being at sixes and sevens” came about because of the dispute about which Worshipful Company, Merchant Taylors or Skinners (furriers), should be ranked six or seven, a dispute over which received its charter first.

I’m indebted to Wikipedia for the following. In 1515, the Court of Aldermen of the City of London settled the order of for the 48 livery companies then in existence, based on those companies’ contemporary economic or political power. The 12 highest-ranked companies remain known as the Great Twelve City Livery Companies. Presently, there are 111 City livery companies, all post-1515 companies being ranked by seniority of creation, the last, number 111, being for nurses.

I was pleased to see there is not a Worshipful Company of Mousecatchers.

Modest Expectations – Voiture ancienne

The Defence force spends somewhere in the region of $40m a year in recruitment of men and women to the army, navy and air force. Nowhere in the advertisements is the message, join the defence force to be killed fighting for your country. Rather, learn skills, enjoy yourself.

So why would a young doctor go into general practice when there is so much moaning in the background about how terrible general practice is. When I was young, I remember “Country Practice”, a TV show which extolled the virtues of general practice. Since then there have been TV doctors featured as dysfunctional, exiled to the country, as for instance in “Doctor, Doctor”. The portrayal involved a great amount of sordid activity. The characters were hardly appropriate role models, but when you watch an optimistic sitcom such as “Call the Midwife”, one wonders how that would play out if moved from an inner London setting to the Australian outback.

I was involved in rural health until about five to six years ago. I have seen very clearly what works and what doesn’t; and it distresses me to see the same suggested solutions rolled out, knowing they have failed previously. One is this bleating about how difficult it all is; and their need for more doctors. Then when a doctor is suggested to join some of these doctors in apparent need, some back away worrying that their income will be impaired.

Then I wrote about the challenges, which I have observed over the years; I doubt whether they have changed. They seem not to have been taken into account in the platitudes in the latest 12 page report supervised by the Minister, who unfortunately seems to have been captured by these purveyors of stuff that does not work. The challenges to rural practice are:

social dislocation
professional isolation
community tolerance
succession planning

Social dislocation is encapsulated in the reluctance of one’s partner to relocate and where the doctor needs to send his/her children away to school. Professional isolation exists in a variety of ways – working on one’s own so that one is effectively rostered on duty 24/7, without locum relief or where one refuses to share on-call with doctors in other practices. I have worked in small communities with hospitals; and well managed they provide an essential resource in enabling work with other health professionals where there are not enough doctors.

Community tolerance is thus at the heart of the inter-relationship with other health professionals and the community. The idea that health professionals will automatically work together, by some magical wafting of a bureaucratic report, is fanciful. Strength of leadership and an ability of the doctor to work in the community needs someone who automatically is expected to join a community and its activity. When there is an immediate barrier of language and customs, not to mention personality traits, expectations may not be fulfilled. Some doctors are not joiners, they do not want to become involved in social activities. Added to this, some doctors need to adjust to the fact that unlike the city, there is no anonymity; one common reaction is to leave the community over a weekend “just to get away”.

Then there is the most important challenge and that is succession planning. Few practices do it, but the ones that do are successful because they promote continuity in service and hence corporate memory and trust among their patients. There should be a rule of thumb that if one survives the initial period, then one should guarantee (and be guaranteed) a certain length of time in one practice. Five years seems to be reasonable in this modern age, where there is fluidity in employment among health professionals. That means that once the number of doctors needed to provide the best possible service is settled, then one works to maintain that level, remembering that what attracts doctors is a functional practice which, implicitly or explicitly, has paid attention to the top three challenges I have listed.

Income is always important, but it is not a specific condition for general practice and the whole matter of Medicare will be dealt with in my next blog.

I have written about rural medical practice endlessly, (my previous blogs attest to this) but the underlying problem is that the bureaucrat writes the report as if the work has been completed. In reality it is only the beginning, because implementation is always the difficult part.

Once they genuflected and cried: Go to Pell

Many shameful episodes in Australian politics in recent years, but hard to think of a lower moment than seeing two former Prime Ministers attend the funeral of a cardinal who covered up institutionalised sexual abuse of children and protected paedophile priests – Twitter comment

My eye was attracted to this comment about Cardinal Pell’s funeral. I have a relative who played football with the young George Pell when he was a journeyman country Australian footballer, a big man (195cm) who shouldered some of the ruck load. My relative was adamant that Pell would never have been a child abuser.

The problem is that Pell did have “form” from his time as a young priest, was criticised by the Royal Commission into Child Abuse, was convicted and imprisoned, and the conviction overturned on technical grounds which did not clear Pell, but the decision indicated that High Court was not convinced that the matter of reasonable doubt had been addressed satisfactorily. The evidence of a monsignor seemed to be believed above the evidence of others, without any real evidence of the veracity of his recall of the circumstances of the accusations made against Pell.

After Pell disappeared to Rome, the Sydney diocese must have started planning for his inevitable death. It was such a highly staged spectacle, seemingly having every Roman Catholic priest recruited for the ceremonial requiem mass. It also seems that the Sydney diocese has decided not to go with the shift in the political winds in Rome, even with the current ailing Argentinian pope, and to combat the progressives who are on the rise. Sydney may decide to become the home of such Roman Catholicism – refusing to consider contraception, abortion, celibacy, the ordination of women, vaccination against cervical cancer and even encouraging the re-introduction of the Tridentine mass (currently four churches in Sydney).

To airbrush Pell is a common trait in Australian culture – turning a scumbag like Ned Kelly into a national hero is another example. Tony Abbott ‘s extravagant comment does not do the situation justice. Abbott is not rabid, in that he has not presumably been bitten by a dog, squirrel or civet. His statement that those outside the cathedral yelling “Pell go to Hell” meant they at least believed in the afterlife and thus this was the first verified Pell Miracle (gained him a few cheap tweets) but was just plain stupid.

The Church cannot be serious about canonisation of a man who has been shown to facilitate, indirectly or directly, sexual molestation of children by a collection of priest predators, some of whom were close to him at some point. Since Peter became the first Bishop of Rome, the Church has survived a great deal of malfeasance, and perhaps this will continue to persist.

The other perception of the Church is how ludicrous some of the regalia looks when placed alongside stated conservative attitudes. After all, look at the fancy dress of the church dignitaries and then fast forward to the forthcoming dress-ups for mardi gras by the queer dignitaries.

And the other intriguing question, will Abbott and his seminarian mates have to wait for a new Pope to get an Australian Cardinal – or will there be a progressive addition to the Curia gifted by Pope Francis? And could he reach beyond the current list of bishops to perhaps a priest of principle, a man with a progressive tinge.

My Country, Ngangkari

It was one of those times when I was in Ernabella, and I was introduced to a young man, who I was told was a ngangkari. Ngangkari is a Western desert name for the medicine man. In every community I understood that there were these people, not necessarily men, who were responsible for the spiritual totems. I became aware of this fact when there was talk of a kadaitcha man when I was working in western NSW in the 90s. Although he was never identified, I was assured that he existed, right down to the feathered feet not leaving footprints. Before this can be dismissed as myth, I wonder if, in the construction of the Voice, whether these medicine men were consulted. Do they still exist, because it is important for the integrity of the Aboriginal traditions given the fragility of oral traditions; to assure the continuity of the spiritual values of each particular tribe.

As I said, at Ernabella I was introduced to a young man, who had been identified as a ngangkari. Like many Aboriginals, he was taciturn, especially confronted by a whitefella “blow-in”. What attracted me to him were his luminous indigo eyes. I was looking into the 40,000 or whatever years of Aboriginal heritage. I tried many approaches to engage him, and the one that worked was when I said “Adelaide Crows”. He broke into a wide smile, and the indigo eyes glinted into the twentieth century. For me, it was important to know that the medicine man existed; it was not for me to interrogate him. He was non-committal in describing his role; but what I knew was how important the oral tradition was to the medicine man/woman and the secrets that had been passed onto this man. By responding to Adelaide Crows meant that this ngangkeri was not set apart from modern life.

Aboriginal healer and artist Betty Muffler, standing on Iwantja, Yankunytjatjara Land in front of her artwork, Ngangkari Ngura (Healing Country), (2020)

The question arises as to where these medicine men and women have been included in defining such an ephemeral notion as the Voice, because so much of the tradition included in the Voice is embodied in oral tradition. This handed down from one generation of medicine man/woman to the next would seem to be more important than a bunch of Aboriginal academics with confected lines, none of which are incorporated in oral tradition that have been lost or remain as an imagined thread.

I just hope that Voice is not an exercise, a grab for power, by some clever Aboriginals without any real links to the oral discourse. It is as if in the same way I would invoke my Irish ancestors in justifying an Irish voice in how Australia is run. In the end so-called “recognition” could be extended to being an implicit right of veto over legislation, as interpreted by a sympathetic High Court so that the end result is a third chamber of parliament in Australia, with all the complications that would bring.

The ongoing judicial interpretation of something as broadly worded as seems to be proposed by the referendum is likely to cause headaches, since Aboriginality may become of one of judicial interpretation. The legal consequences of a successful referendum will move slowly. Without the involvement of those such as the medicine men or women who carry the Aboriginal lore, it is in danger of becoming the plaything of that band of academic Aboriginals, and of course Noel Pearson. I do not have to worry about the unexpected consequences of all this political malarkey which threatens to consume the country’s political life this year, but my grandchildren may.

Our Bicentenary

I was amazed to see how the mangroves are flourishing around Iron Cove in inner west Sydney. The past three years have meant that I have spent little time in a place where, 30 years and more ago, I used to run to maintain fitness. The Iron Bay run is 7 km, and relatively flat. Nevertheless, the run includes a number of microclimates, which make it an interesting route. The problem with Iron Cove, which is one of the estuarine inlets of the Parramatta River, is that it has experienced two centuries of whitefella pollution. One of the major pollutants has been dioxan, and therefore I would never intentionally eat fish or crustacea from the Cove. But others do.

When I used to run the Iron Cove, the mangroves were there, but not to the height and extent as the mangrove forest now. It used to be stunted and did not exhibit its current lushness – rather it was a swamp bordering on the estuary, the water flowing tidally, and at ebbtide, it was a muddy swamp with just a thin cover of mangroves. Now it is different and given the mangrove so essential for water hygiene, maybe the underlying pollution will diminish.

After all, the Parramatta River which is estuarine for a considerable way contains numerous diverticular inlets to enhance its presence and importance. If there had not been such a river, the original settlement would not have survived because the soil around the harbour is poor and shallow on the underpinning sandstone. Gardening in suburban Balmain attests to the need to improve the soil and not dig too deep. The Parramatta River was a gateway to its upper reaches where cereal crops could be grown. In other words, here was the arable land,

In recognition of its importance, to celebrate the Bicentenary in 1988, we ran the Parramatta River from Long Nose Point as far as we could to Parramatta and to where the Toongabbie Creek flowed into it.

Like the mangroves, there has been a cleansing of the Parramatta River and its banks. This has been done without interfering with historic buildings built in the early years of the colony. Then many of the buildings were fenced off and left to rot because they were deemed too expensive to renovate. A large chunk of land with a 220 metre frontage on the Parramatta river was given over to the Department of Defence Naval Stores depot at Ermington, fenced off and like so much of the littoral lands unavailable to public access. In some parts, the other side of the river was available. But there was still a great deal of industrial land to be negotiated, for instance running through the coal dust and railway lines at Camilla. The skun dog carcase added to the sights as we padded along the riverside pathway nearing Parramatta one Sunday.

In 1988, it was an unloved waterway – the industrial sewer, yet with these marvellous sandstone Georgian buildings boarded up; fenced off – then too expensive to renovate. To us, just running it was our tribute to 200 years of European migrant population

Now 44 years later, the NSW Government has announced that it will put $60 million towards the pathway, which has been dubbed the Parramatta to Sydney Foreshore Link, a 91 kilometre path able to be used by both pedestrians and cyclists. It will start by the Harbour and end at Parramatta Park. “In the process, it’ll become one of the city’s longest transport connections, spanning a whopping 18 suburbs,” boasts the media release.

So, there you go, it took us several Sundays to run the distance. We had to make various compromises because the foreshore was unavailable; but what it said to us about 1788, there were many resourceful people who for better or for worse brought their civilisation to this huge continent. While we have despoiled, we have avoided building a country torn apart by waves of invaders battling over territory, because the Australian continent was ignored until the end of the eighteenth century except by a few, who left alone for thousand of years developed a most intricate culture among a remarkably diverse “nation”, yet which needed only one group of invaders to almost destroy it. But then again, Australia could have been colonised like Africa, and then the Continent would have been properly shredded.

How to deal with a Pomegranate

Obviously, pomegranate seed mining presents a problem for Americans, as suggested by this article in the Washington Post. An example of tough love?

Cut the pomegranate in half through the equator, hold a half cut side down in your hand over a dish or bowl and whack it — firmly, confidently — with a wooden spoon.

That’s it. Just make sure you’re hitting the fruit with the underside of the bowl of the spoon, rather than the edge, which is more likely to crack it. If you want to be a little extra, you can roll the fruit around on your counter before cutting to help loosen the seeds, though I didn’t bother. If you’re worried about splatters, use the biggest, widest bowl you have. (don’t do this while wearing white.)

It took me a less than two minutes per half to remove all the seeds, no prying required. Just periodically turn the halves over to see where you need to focus your efforts to ensure all the seeds come out. Very little of the membrane or white flesh ended up in the bowl, and whatever did was easily picked out. If I shook the bowl like I was tossing a salad, the extra bits rose to the top or spun to the edges, making it even simpler, no water needed. After that, it was easy to transfer the seeds to an airtight container in the refrigerator, where they should be good for at least five days, though I’ve pushed it longer. If you want to freeze the seeds for a few months, be sure to place them in a single layer on a lined baking sheet and then pack them in a bag or container once they’re froze.

This simplicity of this method was in stark contrast to the more photogenic technique that infiltrated my Instagram feed, in which you carve out the top and then try to cut the pomegranates into its naturally occurring segments. It took me way longer to do this, as I still had to press and pry out the seeds. Plus, surprisingly, it sent more seeds onto the floor than the whack-it-over-a-bowl method.

As an added bonus, the wooden spoon strategy is incredibly therapeutic. Whack out your frustrations, and then enjoy the fruits of your labour. Win-win.

Mouse Whisper

As he says, his pronunciation leaves something to be desired. Thus, when he pronounced his Citroen as a “Citron”, he wondered why it did not sell, until he was placed in the front of a mirror and given an elocution lesson.